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There are many things you must carefully consider when choosing a nursing facility for yourself or a loved
one. State inspection reports, word of mouth recommendations, and promotional literature can all be helpful. But
when it comes to make a decision, nothing is more valuable than the insight you gain from making personal
visits to the home(s) you are considering.
Things To Observe During Visits
* Is the home well lighted?
* Is the facility free of overwhelming unpleasant odors?
* Is the home as clean and well-maintained as you set your personal standards?
* Do residents appear well groomed?
* Do chairs and other furniture seem sturdy and difficult to tip? Attractive and comfortable?
* Do patient beds have privacy curtains?
* Are those curtains being used by staff to protect the privacy of patients receiving treatments or assistance?
* How do staff members interact with residents? Are they courteous and friendly? Address residents by name?
* Are call lights promptly answered?
* Is there an activities schedule posted? Are residents engaged in activities?
* Do meals appear tasty and attractive?
* Are resident who need help eating receiving assistance?
* Is the food preparation area separate from the dishwashing and garbage areas?
* Is food needing refrigeration not standing on counters?
* Is there fresh water on bedside stands?
* Are there hand rails in hallways and grab bars in bathrooms?
* Are toilets convenient to bedrooms and handicappers?
* Is there a sink in each bathroom?
* Are call bells near each toilet?
* Are the hallways wide enough to accommodate passing wheelchairs?
* Are the rooms large enough to allow a wheelchair to maneuver easily?
* Is the temperature comfortable (remember many seniors prefer warmer environments)?
* Do all patient rooms have windows?
* Do all residents have closets and drawers for clothing?
* Is the atmosphere generally friendly and welcoming?
Questions To Ask Facility Staff
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* Are beds available?
* Does the home have a current license from the state? Does the administrator have a current license from the
sate? If not, do not use the home.
* If Medicare and/or Medicaid coverage is needed, is the home certified?
* How does the facility match roommates?
* Does the home have a formal quality assurance program?
* Does the facility have an operating agreement with a nearby hospital for emergencies?
* Is a physician available in an emergency?
* Are personal physicians allowed?
* How is regular medical attention assured?
* How are patients and families involved in treatment plans?
* Are other medical services available (i.e., dentists, podiatrists, optometrists)?
* Does the facility report periodically to the patient's personal physician on resident progress? To families?
* What services are provided for terminally ill patients and their families?
* Does the home have an Alzheimer's disease program?
* Is a licensed nurse always available?
* Does a pharmacist review patient drug regimens?
* Are arrangement made for patients to worship or attend religious services as they please?
* Is there a physical therapy program available under the direction of a qualified physical therapist?
* Are services of an occupational therapist or speech pathologist available?
* How are residents encouraged to participate in activities?
* How are patient activity preferences respected?
* Are group and individual activities available?
* Is a social worker available to assist residents and families?
* Does a dietician plan menus for patients on special diets?
* Are personal likes and dislikes taken into consideration in menu planning?
* Are snacks available?
* Is assistance in bathing and grooming available?
* Are barbers and beauticians available?
* How are disputes, problems, or complaints with the quality of care settled?
* Does the facility have
a written description of
patient rights and responsibilities?
* Is staff trained to protect
patient dignity and privacy?
* Does the facility have
Resident and Family Councils?
* Are all services covered
in the basic daily charge?
* If not, is a list of specific services not covered in the basic rate available?
* Will the home help you with third-party (insurance) billing?
* Are advance payments returned if the patient leaves the home?
* Does the home regularly survey residents or family members to find out how satisfied they are with
the quality of services the home provides?
Questions To Ask Yourself
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* Do I feel comfortable coming here/leaving my loved one here?
* Is the location of the facility convenient for frequent visits of family and friends?
* Is the facility convenient for the patient's personal physician?
* Am I committed to continuing involvement in my loved one's life and care (i.e. personal visits, serving
on council, etc.). * How is quality care assured?
All Georgia nursing homes are inspected at least once a year by state and federal survey teams. State inspectors,
many of whom are registered nurses, check every aspect of nursing home care and resident living.
These nursing homes must pass over 500 state and federal regulations (over 300 pages), making the long-term
care industry one of the most regulated in the nation. As of October 1, 1990, the most massive reform in nursing
home history became the centerpiece of care with the resident as its ultimate focus. The Georgia caregivers
are highly supportive of these regulations and will do everything possible to see they are enforced.
ANSWERS TO QUESTIONS ABOUT NURSING HOMES
Who Lives In A Nursing Home
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* In the state of Georgia, approximately 40,000 elderly, handicapped or convalescent persons depend on the nursing
home to provide medical and nursing care, activities and social services. These residents can no longer
live alone nor can their needs be met by their families. About 75 percent of those living in nursing homes
are women.
What Happens In A Nursing Home
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Today's nursing homes are quite different from the homes of decades ago. The attitude of the public is changing
as it is constantly reminded that a nursing home emphasizes rehabilitation, community involvement, encouragement
of resident "living" and focus on the residents' total needs. In Georgia, residents participate in
a variety of activities led by activity directors specially trained in recreational therapy. Activity directors
receive constant education to assure that their residents enjoy the benefits of the most recent findings in
gerontological recreational research. The days of just playing Bingo are past.
Every year, residents are encouraged to vote, attend parades, participate in cultural events and picnics.
Bridge parties, sewing bees, senior proms, fishing, gardening and a multitude of other creative events fill their
days. Activity directors are recognized for their resourcefulness as they transform the nursing home's
dining room into an Italian pizza parlor or a French bistro.
The annual Ms. Georgia Nursing Home Pageant sees statewide competition based on a lifetime
of achievement as 500 young-at-heart ladies ranging from 51 - 100 years old compete for the coveted crown and the
opportunity to represent the residents of Georgia's nursing homes. Adopt-a-Grandparent programs, Easter egg hunts
and Trick-or-Treat, are home-sponsored events for local school children eagerly planned and attended by
the residents.
Who Pays For Nursing Home Care
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A poll conducted by the Gallop Organization revealed the following:
* 1 in 5 people believe that Medicare covers extended nursing home care.
* 7 of 8 said they do not know how they would pay for health care in their retirement years.
* 1 in 4 said they did not know how they would pay for extended care in a nursing home if a family member
needed it now.
Surprising to many people, Medicare plays only a minor role in covering nursing home expenses. Medicare
benefits are restricted to 100 days of coverage per spell of illness. less than 6% of nursing home
care nationwide is paid for through Medicare. In Georgia, over 80% of all residents are Medicaid recipients.
Medicaid funds come from state and federal taxes. Unfortunately,Georgia ranks poorly in terms of reimbursement
rates from the state, with the average being $75 per day, less than $3.20 per hour of care. These funds
must pay for nursing care; all meals; a clean, safe room; activities; social services and much more.
Patients and families are beginning to have to shoulder more of the payment responsibility.
Residents rely on the Medicaid system to pay for their care. This, coupled with the health care demands
of America's poorest population, is causing the Medicaid system to buckle and lawmakers to demand sweeping changes.
Because the Medicaid portion of the federal budget has continued to grow so quickly, Congress is now considering
many changes to the system that are expected to drastically alter both the medical services
covered by the program and the eligibility standards for receiving assistance. With average long term care
costs edging upward to $30,000 per year where does that leave the average citizen? Protecting Access: As Baby
Boomers continue to age, it is expected that demand for long term care services will soar. At the same time,
federal and state governments are expected to continue backing away from the massive responsibility of paying
for the health care needs of the elderly. Without a doubt, it is the people who plan today that will
have the best access to the care they need tomorrow.
Protecting Choice:
People who rely on Medicare, Medicaid or relatives to fund the cost of their care often face very limited
choices when it comes to selecting care. Their range of choices is determined by either what their personal
or family budgets can afford or whatever public services for which they are able to qualify. By planning
in advance, consumers can ensure their access to all types of long term care services available - and
preserve their ability to make choices.
Protecting Assets:
If the idea of dwindling life savings and selling off some of your family's assets to finance long term
care frightens you - then asset protection is a third good reason to consider long term care insurance.
Some people avoid taking responsibility for paying for their care now by divesting or giving away their assets
to their children prior to needing long term care so they can qualify for welfare support. This can
be a painful process for loved ones and is a gamble at best since laws governing divesture are expected to
get tighter as lawmakers search for ways to control rising health care costs.
Can I Afford Long Term Care Insurance
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* The cost of long term care insurance policies vary according to many factors such as the age of the policy
buyer and the conditions of coverage.
* Many excellent policies are available at premium rates that generally range between $800 and $2,500
per year with younger buyers (age 50 - 60) paying lower premiums and older buyers (65 to 80+) paying more.
The real question is, can you afford not to purchase long term care insurance?
Long Term Care Insurance
What to Look For In A Policy:
When you are ready to select a policy, it is important to seek the advice of a licensed
insurance agent who is trained in long term care insurance products to assist you with your selection. Below are
some elements of coverage to discuss with your agent.
Scope of Services Covered:
The best products pay a benefit that can be used in a wide variety of long term care settings,
including homecare, assisted living, and skilled nursing. Be careful of policies that restrict your coverage to
only one type of care or pay a benefit for only certain ailments or illnesses. Daily Benefit Amount: This is
the amount the policy will pay per day for care. Consider the average cost of care per day in your area and
decide how much you want covered by insurance and how much you think you can pay out of pocket. Policies
typically cover expenses of about $100 per day but policies can be tailored to cover greater or lesser amounts.
Benefit Period:
This is the length of stay your policy will cover. Lifetime coverage is available, although many people choose
coverage periods between 2 and 5 years, since nursing home stays are rarely longer
than this period.
Deductible/Elimination Period:
This is the length of time you must pay for care yourself before the policy kicks in. The
longer the deductible period - the lower your premiums.
Inflation Protection:
It is important to buy either simple or compound adjustment inflation riders with your policy - especially if you
are a younger buyer.
Finally, make sure any policy you buy is guaranteed renewable - meaning your policy can't
be cancelled for any reason other than non-payment of premiums. With the help of a qualified agent, comparison
shop among policies. Many offer unique incentives for buying their product such as discounts if both
spouses buy policies and lapse protection to keep your policy from being automatically cancelled if you accidently
forget to pay a premium.
Nursing Home Statistics
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Although the following information is provided as numbers, we must remember each number represents a person who
may need help with bathing, dressing, eating and walking. Over the years, their numbers will grow, and in reality,
will someday include our family members, our friends, ourselves.
The primary factors leading to nursing home care are:
absence of family; exhaustion of financial resources; burden on existing family members; women, who are
traditional caregivers, are increasingly in the work force rather than at home; family size has decreased
markedly over the last 30 years so fewer children are able to assist elderly parents; rising life expectancies
many children will find themselves caring for very old parents while they are themselves elderly and lacking
stamina.
By 2030, there will be about 65 million older people, two and one-half times their number in 1980. The most
rapid increase is expected between the years 2010 and 2030 when the Baby Boom generation reaches 65.
The 32 million Americans who are 65 or older make up 13% of the population, but account for 44% of all
days spent in the hospital; 40% of all visits to internists and one-third of the nation's health care expenditures.
However, only 13 of the 126 U.S. medical schools require either a course or a clinical rotation in
geriatrics. (New York Times News Service)
The U. S. Department of Health and Human Services recently reported the following breakdown on how nursing
home care is paid for nationwide:
* 44% from out-of-pocket
* 43% covered by Medicaid and Medicare took 8% of nursing home spending
* Private health insurance only paid for 1%
* Veterans Administration and other sources contributed 4%.
Additional Statistics
* Only 63% of older nursing home residents have children, compared to 81% of older people in the community.
* In Georgia, approximately 82% of all residents are Medicaid funded. This is nearly twice the national
average. Since 1981, the nursing home portion of the state Medicaid budget decreased from 44% to about
20% currently, while the number of residents increased.
* The figures derived from the 1990 census show that the nursing home population increased by 24% in the
1980s numbering just under 1.8 million nationally.
* Low Medicaid reimbursement has many repercussions as quality care becomes threatened.
Nursing homes have tremendous difficulty in competing for nurses with hospitals and other health services.
The U. S. Department of Health and Human Resources estimates that 125% more registered nurses and 142%
more licensed practical nurses will be needed in the next decade just to meet the growing demand
in long-term care.
Women are more likely than men of comparable ages to enter a nursing home. The lifetime risk of being in
a nursing home for women at age 65 has been estimated at 52% and that for men at 30%.
* Nursing homes are one of the nation's most heavily regulated industries. For example, the State or Federal
agencies have the authority to impose monetary fines up to $10,000 per day, suspend admissions to the facility,
cut off Medicaid funds, place monitors in the homes and hire temporary managers to operate the nursing home
if a home is having repeated difficulty in complying with the over 300 pages of regulations they must
pass with each survey.
* Nearly 84% of nursing home residents are without a spouse, as compared to 45% of the living-at-home elderly.
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